Waiver redesign will bring substantial benefit changes

Posted: Tuesday, Apr 30th, 2013BY: Ed Close, Herald Reporter

EVANSTON — The waiver redesign being conducted by the Wyoming Department of Health is likely disturbing to those whose lives will be most affected by it, to say the least, and the seminar held April 17 to explain the reasons behind the changes, and the process of the waiver redesign left more questions than answers.

The waiver redesign was mandated by the state legislature when Senate Enrolled Act 52 was passed in 2012. The state now has no choice but to redesign its waiver system for the services it provides to Medicaid recipients. Three Medicaid option studies were completed and presented to the Joint Labor, Health and Social Services Interim Committee and the Joint Appropriations Committee. After review by those committees, the second option plan was approved as Senate Enrolled Act 82.

The presentation given in Evanston represents a beginning to that redesign study, as public input and input from providers is supposed to be used in redesigning the waiver system. Before any rules or regulations can be drawn up or implemented, three areas of study are required to be completed. The Department of Health must identify cost drivers, identify waiver wrap-around medical service costs and identify cost savings including successful methods for cost savings implemented by other states.

The home- and community-based waivers in question are all funded by 50 percent state general funds and 50 percent federal funds. The Medicaid and Medicare are being cut by four percent on the federal level due to current legislation, and these cuts will travel through the federal level to the state level, but also from the state level to counties and cities across the nation including, of course, those in Wyoming.

What this study for waiver redesign is concerned with is home- and community-based waiver systems in place within our state. Other studies are being conducted in other areas of the healthcare system in Wyoming, too, though the seminar held April 17 was ostensibly held to discuss only the systems affecting people with developmental disabilities, child development disabilities and acquired brain injuries in the current system.

Residential and day habilitation services are the highest identified costs within the current system, with $65.5 million out of a budget of $82.9 million being spent for those services. The federal government is assigning no additional funding to the state of Wyoming, but has mandated that 534 individuals currently on waiting lists be brought in, and those numbers are growing within our state.

As of March 31, those on the waiting list were delayed for 23 months before receiving services. The longest identified wait from current lists is over five years, however. The mandated regulations specify the waiting lists have to be significantly reduced, and what is being proposed is a reduction of budgets and services to individuals already receiving assistance in order to serve those currently on the waiting lists. No other funds are available to the state to reduce those numbers, and cutting existing services to individuals already receiving assistance has been suggested to be the only way to meet the new requirements.

“None of the changes are happening overnight or even within the next six months,” documentation from the April 17 presentation cautioned.

Though the subject is complicated and hard to understand at face value, it is important to understand the primary focus of the waiver redesign is to change the current waiver system to reduce costs and increase community involvement and independent living. In short, more clients receiving these services will be forced to live on smaller budgets, and possibly seek assistance from family or community organizations in order to maintain the quality of life they now have.

There will be cuts to current assistance, and the burden of those cuts will fall on those least able to compensate for the reductions in funding, not to mention their families and their communities at large.

The proposed new waiver system will replace the current Adult Developmental Disabilities Waiver, the Child Developmental Waiver and the Acquired Brain Injury Waiver with a Support Waiver, a Comprehensive Waiver and the Acquired Brain Injury Waiver.

There are four main changes mandated by Senate Enrolled Act 82, though interpretations vary on how the new law is supposed to work.

The first change is to create two separate waivers, a support waiver and a comprehensive waiver. The second change is the optimization and extension of services, and to replace high-cost residential and day habilitation services with lower cost ones. The third change is to create individual budget amounts (IBAs) for each person served on waivers, based on individually-assessed needs. The last required change is to replace the present case management system with a new one that is free of conflicts of interest, meaning case managers cannot be employed by any provider a client receives services from.